Abstract
PROBLEM STATEMENT: Despite massive national efforts to scale up Antiretroviral Therapy (ART) access in India since 2004, the AIDS death rate was 17.2 per 100,000 persons during 2003-2005. In the era of HAART in resource poor settings, it is imperative to understand and address the causes of AIDS related mortality. This collaborative study aimed at defining the predictors of mortality among people living with HIV/AIDS (PLHA) admitted during 2003-2005 to the Freedom Foundation (FF) Care and Support facility, Bangalore, India. APPROACH: Fifty consecutively selected HIV-infected patients who died during the study period and 50 HIV-infected patients matched by age, gender, route of transmission, nutrition status and stage of disease who survived at least 12 months post-ART were included in this study. The impact on mortality by factors such as: Hemoglobin, CD4+T lymphocyte counts, weight loss and Opportunistic Infections (OIs) were studied. Statistical analyses were done by Chi-square, Fisher's Exact Test, Kaplan-Meier and multivariate logistic regression. RESULTS: Recurrent diarrhea was a significant risk factor for mortality (OR = 12.25, p = 0.004), followed by a diagnosis of pulmonary tuberculosis (TB) at first admission (OR = 4.86) while TB in general also negatively impacted survival (p = 0.002). Though not statistically significant, Pneumocystis carinii pneumonia, Cryptococcal meningitis and Toxoplasmosis also negatively affected survival. Mortality was high among those not on HAART (81%) while it was significantly reduced (28%) among those on HAART (p<0.001). Patients who died had elevated liver enzymes (p = 0.027) and significant weight loss (p = 0.012). Mortality was high among patients irregular with their medical follow-up (p<0.001). CONCLUSION: Interventions that facilitate early OI diagnosis and treatment especially diarrhea and TB may reduce mortality in HIV. HAART alone without proper OI management and nutrition did not prevent mortality among PLHA. In resource poor settings, it becomes imperative to focus on low cost tools and increased capacity building along with regular clinical follow-up for diagnosis and early treatment of OIs. Further studies are warranted to explore benefits of initiating HAART earlier than currently recommended.
Highlights
According to India’s National Family Health Survey (NFHS-3), the prevalence of HIV in the country is 0.3%
The study was conducted at a community care center run by Freedom Foundation, an Indian nongovernmental organization based in Bangalore, India
AIDS related wasting and general debility syndrome with nevirapine living with HIV/AIDS, people living with HIV/AIDS (PLHA), visiting the clinic once in three months and/or as advised by the doctor), 81% of those not on HAART died during the study period while among those on HAART, 28% had died which was a significant difference (p
Summary
According to India’s National Family Health Survey (NFHS-3), the prevalence of HIV in the country is 0.3%. Even with this reduced prevalence, India would still contribute to 30% of the HIV epidemic in Asia[1]. The national government is engaged in addressing the devastating HIV/AIDS epidemic utilizing several interventions, including free access to antiretroviral therapy launched in 2004[2]. Increased access to treatment is likely to reduce mortality among HIV-infected individuals, there are studies in India that show that AIDS-related deaths is still about 9.73% in the present HAART era[3]. The study described aimed to examine factors that predicted death among inpatients in the clinical setting of guidelines-based HAART access
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